I’ve blogged previously about how Medicare avoids administrative costs by permitting waste and fraud. Now it appears that Medicare avoids public scrutiny about fraud by covering it up. Today’s New York Times reports:
Medicare’s top officials said in 2006 that they had reduced the number of fraudulent and improper claims paid by the agency, keeping billions of dollars out of the hands of people trying to game the system.
But according to a confidential draft of a federal inspector general’s report, those claims of success, which earned Medicare wide praise from lawmakers, were misleading.
In calculating the agency’s rate of improper payments, Medicare officials told outside auditors to ignore government policies that would have accurately measured fraud, according to the report. For example, auditors were told not to compare invoices from salespeople against doctors’ records, as required by law, to make sure that medical equipment went to actual patients.
As a result, Medicare did not detect that more than one-third of spending for wheelchairs, oxygen supplies and other medical equipment in its 2006 fiscal year was improper, according to the report. Based on data in other Medicare reports, that would be about $2.8 billion in improper spending.
That same year, Medicare officials told Congress that they had succeeded in driving down the cost of fraud in medical equipment to $700 million.
Some lawmakers and Congressional staff members say the irregularities that the inspector general found were tantamount to corruption and raise broader questions about the credibility of other Medicare figures.
The article discussed the extent of Medicare fraud:
Equipment sellers have submitted counterfeit documents, forged doctors’ signatures and filed claims on behalf of patients who were dead or had never been seen by the prescribing physician, according to many reports by government oversight agencies.
For example, a Florida businessman was sentenced last year to 37 months in prison for submitting more than $5.5 million of fake claims to Medicare. The businessman operated for months, despite giving the agency an address that was actually a utility closet…
Medicare reported to Congress that, for the fiscal year of 2006, AdvanceMed’s investigations had found that only 7.5 percent of claims paid by Medicare were not supported by appropriate documentation. But the inspector general’s review indicated that the actual error rate was closer to 31.5 percent.
For instance, according to the report, the Office of Inspector General examined a claim for an electric wheelchair that AdvanceMed had said was appropriate. The inspector general’s investigation revealed that the physician who was listed as having prescribed the wheelchair had no knowledge of the prescription.
The person who received the wheelchair said that he had never met with the physician, that he did not need a wheelchair and that he had never used it, according to the report. His wife had also received a wheelchair that she had not asked for and never used.
Equipment sellers can pocket more than $2,500 every time they send a powered wheelchair to a patient and bill Medicare.
Don’t worry, though, because your congresscritters are on the job:
On July 1, Medicare instituted a new competitive bidding system that officials said would reduce both fraud and costs for medical equipment.
On July 15, however, Congress suspended the program, after equipment manufacturers and sellers began an aggressive lobbying campaign.
A leading congressional watchdog was outraged:
“This is outrageous,” said Senator Charles E. Grassley of Iowa, the top-ranking Republican on the Senate Finance Committee, who has repeatedly credited the Centers for Medicare and Medicaid Services with reducing improper expenditures. “If heads don’t roll, you can’t change the culture of this organization,” he added.
To clarify, Grassley was of course referring to the culture of Medicare, not Congress.
Another congressional watchdog had seen it all before:
“This report doesn’t surprise me,” said Representative Pete Stark, Democrat of California and a senior member of the Ways and Means Committee. He has pushed to cut improper Medicare spending. “To look better to the public, you cook the books,” he said. “This agency is incompetent.”
Of course, Pete Stark’s solution for Medicare’s incompetence is to force you to enroll:
There is a road map laid out for us…Medicare. Medicare has lower administrative costs than any private plan on the market…Medicare has shown us the power of simplicity; we need only expand its promise to the rest of our population.
Medifraud for all!